Each year, millions of people use both illegal and legal drugs.
If you use drugs, or are likely to use drugs in the future, please read this.
definition: drug
noun
- “a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.”
General guidelines for all substances
Test your drugs where relevant, as adulterants are common in many drugs. “My guy gets pure stuff” is a very popular but dangerous belief. A dealer knowing their stuff doesn’t tell you anything about their supply chain.
Start low (dosage), go slow
Have at least one friend who serves as a sober sitter, especially for first experiences with any drug
Be aware of the laws where you live. Unfortunately, in many cases, the harms of criminalization of drug users substantially exceeds the harms from the drug use itself.
Spend ~2+ hours researching any drug you’re considering using (reading trip reports doesn’t count) before taking it for the first time
Most US states, though sadly, not all, give you immunity when the ambulance/police arrive from drug possession if you call 911 for someone who needs help. See a map of state laws here. Call an ambulance if someone needs help.
Try and avoid using drugs to deal with anger or sadness.
1. Drugs - nicotine, alcohol and opioids in particular - kill thousands of people each year
Drugs Involved in U.S. Overdose Deaths. Source: CDC
Top 5 drugs by number of deaths per year in the US:
- 480,000 deaths per year: nicotine in the form of cigarettes1
- 88,000 deaths per year: alcohol2
- 60,000 deaths per year: opioids including fentanyl, heroin, codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), methadone3 4
- 10,500 deaths per year: cocaine4
- 7,500 deaths per year: methamphetamine4
These numbers are of course biased, because more people use alcohol than use methamphetamine.5
2. Addiction and dependence rates vary wildly depending on the kind of drug
| Drug | Proportion of people who used outside of medical settings that become dependent6 |
|---|---|
| Tobacco | 32-68% |
| Alcohol | 15-23% |
| Heroin | 23% |
| Cocaine | 17-21% |
| Stimulants | 11% |
| Anxiolytics (includes benzodiazepines) | 9% |
| Analgesics i.e. pain relievers | 8% |
| Cannabis | 9% |
| Psychedelics | 5% |
This surprised me when I read it, too. I was expecting to see that 50%+ of heroin users would become dependent, but, that isn’t the case.
3. Before you use any substance, you should research two things
How safe or dangerous is it? How does it compare to other drugs? What are the downsides? What are the upsides?
If you choose to use it, how can you do so in a way that minimizes potential harms to yourself or others, and maximizes potential benefits?
As a good approximate rule of thumb, plan on doing at least 2 hours of thorough research (reading trip reports does not count) into any substance you’re considering trying, before using it. Avoid ever using substances on a whim without research beforehand if e.g. offered at a party.
Part of researching safe use will involve researching which drug combinations are dangerous.
Comparing upsides of substances
From this we can see that caffeine has a upside-downside curve that is weighted much more to the positive, in contrast to Facebook and tobacco which are weighted much more to the negative.
Note: E-cigarettes were not surveyed separately. Their upside-downside profile would likely be different compared to tobacco/cigarettes more generally.
Drugs kill thousands of people each year - we do not endorse the use and acquisition of drugs, legal or illegal. If you make the choice to use any substances, including alcohol, please do your research.
| Substance | % Worse without | Respondents that had tried | Number worse without7 |
|---|---|---|---|
| The internet | 83.4% | 862 | 719 |
| Psychedelics in general | 80.1% | 819 | 656 |
| Smartphones | 73.4% | 848 | 622 |
| YouTube | 72.0% | 832 | 599 |
| LSD | 71.9% | 1023 | 735 |
| MDMA (100% MDMA or high MDMA content) | 67.8% | 723 | 490 |
| Smoked cannabis | 65.7% | 1316 | 865 |
| Magic mushrooms | 64.6% | 845 | 546 |
| Caffeine | 63.1% | 1298 | 819 |
| 61.6% | 856 | 527 | |
| Vaporized cannabis | 59.1% | 975 | 576 |
| Television (including Netflix) | 56.0% | 811 | 454 |
| Edible cannabis | 53.2% | 1074 | 571 |
| Amphetamine (incl Adderall) | 51.3% | 874 | 448 |
| DMT (N,N-DMT, the one with entities) | 48.2% | 432 | 208 |
| MDMA (Ecstasy, purity/contents unknown) | 47.9% | 774 | 371 |
| Porn | 45.7% | 851 | 389 |
| Stimulants in general | 44.8% | 669 | 300 |
| Ketamine | 42.6% | 516 | 220 |
| Alcohol | 42.6% | 1297 | 552 |
| Sugar (including in food) | 41.9% | 821 | 344 |
| Kratom | 36.4% | 516 | 188 |
| 2C-B | 36.2% | 473 | 171 |
| Benzodiazepines (Xanax, etc) | 35.1% | 816 | 286 |
| Nitrous oxide | 30.8% | 591 | 182 |
| Codeine | 29.1% | 553 | 161 |
| Opioids in general | 25.3% | 498 | 126 |
| Peyote (mescaline) | 24.8% | 298 | 74 |
| Oxycodone | 23.7% | 510 | 121 |
| Hydrocodone | 23.7% | 532 | 126 |
| Tobacco (nicotine) | 22.6% | 1123 | 254 |
| 21.7% | 635 | 138 | |
| Cocaine (snorted) | 19.9% | 693 | 138 |
| 5-MeO-DMT (contained in one psychoactive toad and some plants) | 19.0% | 274 | 52 |
| 15.5% | 768 | 119 | |
| Salvia | 14.3% | 427 | 61 |
| Methamphetamine (incl Desoxyn) | 13.4% | 344 | 46 |
| Other 2C-x (2C-I, etc) | 13.0% | 324 | 42 |
| Heroin | 10.3% | 331 | 34 |
| Crack (smoked) | 4.3% | 301 | 13 |
| Synthetic cannabis (Spice, K2, etc) | 3.9% | 539 | 21 |
View these results as images instead: https://imgur.com/a/ElbJh.
Comparing downsides of substances
| Substance | % Better without | Respondents that had tried | Number better without7 |
|---|---|---|---|
| Synthetic cannabis (Spice, K2, etc) | 59.2% | 539 | 319 |
| 55.0% | 768 | 422 | |
| Tobacco (nicotine) | 49.9% | 1123 | 560 |
| Heroin | 43.5% | 331 | 144 |
| Alcohol | 35.4% | 1297 | 459 |
| Methamphetamine (incl Desoxyn) | 33.7% | 344 | 116 |
| Crack (smoked) | 33.6% | 301 | 101 |
| Sugar (including in food) | 33.3% | 821 | 273 |
| Benzodiazepines (Xanax, etc) | 32.2% | 816 | 263 |
| Oxycodone | 32.0% | 510 | 163 |
| Opioids in general | 31.7% | 498 | 158 |
| Hydrocodone | 29.9% | 532 | 159 |
| Cocaine (snorted) | 28.7% | 693 | 199 |
| Porn | 28.3% | 851 | 241 |
| 25.8% | 635 | 164 | |
| Codeine | 23.2% | 553 | 128 |
| Stimulants in general | 19.1% | 669 | 128 |
| Television (including Netflix) | 18.7% | 811 | 152 |
| 18.7% | 856 | 160 | |
| Salvia | 18.5% | 427 | 79 |
| Amphetamine (incl Adderall) | 17.7% | 874 | 155 |
| MDMA (Ecstasy, purity/contents unknown) | 17.4% | 774 | 135 |
| Smoked cannabis | 17.1% | 1316 | 225 |
| Smartphones | 14.5% | 848 | 123 |
| YouTube | 12.6% | 832 | 105 |
| Nitrous oxide | 12.4% | 591 | 73 |
| Vaporized cannabis | 10.3% | 975 | 100 |
| Other 2C-x (2C-I, etc) | 9.9% | 324 | 32 |
| Caffeine | 9.9% | 1298 | 128 |
| The internet | 9.5% | 862 | 82 |
| Edible cannabis | 9.5% | 1074 | 102 |
| Ketamine | 7.6% | 516 | 39 |
| MDMA (100% MDMA or high MDMA content) | 7.5% | 723 | 54 |
| Kratom | 6.8% | 516 | 35 |
| 5-MeO-DMT (contained in one psychoactive toad and some plants) | 6.6% | 274 | 18 |
| LSD | 5.2% | 1023 | 53 |
| 2C-B | 5.1% | 473 | 24 |
| Psychedelics in general | 3.3% | 819 | 27 |
| Peyote (mescaline) | 3.0% | 298 | 9 |
| DMT (N,N-DMT, the one with entities) | 3.0% | 432 | 13 |
| Magic mushrooms | 2.6% | 845 | 22 |
“These people must be lying to themselves - only 56.5% (100% - 43.5%) of people don’t think they’d be better off without heroin”, you say? Remember, around 77% of people who use heroin outside of a medical setting *do not* become dependent, so it makes sense why 56.5% of people who had used heroin in a survey wouldn’t be particularly concerned about it, because based on the research 77% of those who had tried it in non-medical settings wouldn’t have become dependent.
Comparing safety of substances
A paper by David Nutt compares the harms of drugs.8
The blue bars (harm to users) are independent of the popularity of the drug, while the red bars (harm to society) are dependent on the popularity of the drug. Even if the same number of people used MDMA as use alcohol, their blue bars/harm to users scores would still be the same.9
“Finally, we should note that a low score in our assessment does not mean the drug is not harmful, since all drugs can be harmful under specific circumstances.”8
4. Sugar is considered a drug under some definitions
My understanding is that sugar has a physiological effect,10 and so then at least using the definition of ‘drug’ provided by Google, sugar would be considered a drug.
I used to believe that fat people were lazy, and I was a strong advocate for the ‘calories in, calories out’ model, where all you need to do to lose weight is to eat fewer calories than you burn.
I now believe it’s not so simple. The things that changed my mind were:
This podcast episode by Robert Lustig, thanks to a friend for showing me it.
Sugar dependence seems to be very real. I’ve talked with someone who struggled from sugar dependence, and their sugar dependence seemed to cause them immense pain and heartache, and they had extreme difficulty finding effective treatments.
5. Safety information to read first if you’re likely to use specific substances
Opioids, benzos, crack, meth, alcohol, tobacco, or spice
Think about re-considering. These are the substances which the highest percentage of people who believe their life would be better if those substances didn’t exist.
Also, tobacco seems to have the highest rate of dependence of all drugs, with 32-68% of people who use tobacco once ending up dependent on it. Even heroin is substantially lower, with 23% of people who use heroin at least once outside of a medical setting becoming dependent.6
For people who have used alcohol or nicotine (cigarettes) in the past 12 months, it’s even worse - 50% (!) of people who used alcohol in the last 12 months in this study were clinically defined as alcohol dependent, and 80% of people who used nicotine in the last 12 months were defined as nicotine dependent.11
Opioids
Watch this: The Drug Classroom.
Readings: One, two, three, four, five, and finally six (more thorough). Information for friends of opioid users: one.
Crack
Readings: crack harm reduction.
Benzos
Video:
Websites:
Nice easy read, well formatted: DrugScience by David Nutt et al
Scientific journal article “Benzodiazepine harm: how can it be reduced?”
Tapering guide thanks to tylerdurden1993
Alcohol
Watch: Alcohol - The Drug Classroom
Read: alcohol harm reduction, this, and another guide.
Methamphetamine
Watch: Meth - The Drug Classroom
Cocaine
Watch: this video
Read: this, this awesome guide, this and this
Tobacco
Watch: Tobacco - The Drug Classroom
Spice
Read: this PDF about Spice/K2 harm reduction.
Other stimulants such as Adderall, Vyvanse, Ritalin, Amphetamine
Watch: Adderall - The Drug Classroom
Read: This guide, this, AddySafe, this and this
Caffeine
Watch: Caffeine - The Drug Classroom.
Readings:
MDMA
Watch: MDMA - The Drug Classroom.
Read: How to Take MDMA - RollSafe.
LSD, Shrooms, other Psychedelics
Watch: Psilocybin (Mushrooms) - The Drug Classroom.
Read: How to take LSD and how to take Shrooms, and this guide on LSD
Ketamine
Watch: Ketamine - The Drug Classroom.
Read: Ketamine - DrugScience and this great set of ketamine harm reduction strategies, and this guide, and this
Salvia
Read: Salvia - TripSafe and Salvia - DrugScience. This list of supplements for reducing anxiety is meant for classic psychedelics but should apply to salvia also.
Sugar
Listen to this podcast episode by Robert Lustig.
Limit intake to 10% of calories - on average, this would mean less than 50g total sugar per day for women, and less than 63g total sugar per day for men.
Facebook, Twitter
Read this article about app addiction.
If you need help, try:
Cannabis
Just because a substance has exceptionally low risk of acute harm doesn’t mean that you won’t learn useful things from a small amount of research!
For smoked cannabis, read: this guide. If you get anxiety when smoking, this list of supplements for reducing anxiety is meant for classic psychedelics but should apply to cannabis also.
For edibles, read: edibles guide by TripSafe and this guide.
Generally, read this.
References
- https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm [return]
- https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm [return]
- https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html [return]
- https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates [return]
- https://www.drugabuse.gov/national-survey-drug-use-health [return]
- https://www.ncbi.nlm.nih.gov/pubmed/21145178 [return]
- https://docs.google.com/document/d/11qE-gGHLeqsq_nRYk73iHcxWMNUu0OQghZOUYN-1faA/edit [return]
- Nutt, D. J., King, L. A., & Phillips, L. D. (2010, November 01). Drug harms in the UK: A multicriteria decision analysis. The Lancet, 376(9752), 1558-1565. doi:10.1016/s0140-6736(10)61462-6 [return]
- https://drugscience.org.uk/drug-harms-in-the-uk/ [return]
- http://neuro.hms.harvard.edu/harvard-mahoney-neuroscience-institute/brain-newsletter/and-brain-series/sugar-and-brain [return]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621326/ [return]